Provider Demographics
NPI:1619521184
Name:ROOTS TRANSPORTATION LLC
Entity Type:Organization
Organization Name:ROOTS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-258-4471
Mailing Address - Street 1:2012 SAN JUAN BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2220
Mailing Address - Country:US
Mailing Address - Phone:505-258-4471
Mailing Address - Fax:505-436-2294
Practice Address - Street 1:2012 SAN JUAN BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2220
Practice Address - Country:US
Practice Address - Phone:505-258-4471
Practice Address - Fax:505-436-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)